Structural Interventions for HIV Prevention in the United States, Adaora Adimora & Judith Auerbach, Journal of Acquired Immune Deficiency Syndrome (JAIDS), 2015

Creating an HIV prevention plan or an “End the Epidemic” plan requires so much more than understanding the routes and risks of HIV transmission. Time and again, the data show that the behavioral and social parts of an individual’s life affect their risk of acquiring HIV. Some of these social and behavioral factors include race, sex, age, and community support. This paper by Adimora & Auerbach focuses on four areas of structural intervention which can effectively target the social determinants of HIV transmission: comprehensive sex education, syringe exchange programs, health care availability, and stable housing.

Health care access is a critical component of ending the HIV epidemic, especially since “treatment as prevention” and U=U are scientifically-proven truths. Stable housing can contribute to greater access to care as well as reduced participation in “risky” behaviors. In 2019, however, two of the most critical pieces of the puzzle are access to comprehensive sexual health literacy and care and legal syringe access programs. Sexual health education is a right, and all young people deserve to have scientifically-based, honest information about sex and risk. Not only will this allow for a deeper understanding of HIV transmission, but it will create the framework through which young people can form healthy and communicative relationships and communities. This is doubly true for young people who are in out-of-home care or juvenile detention – many represent the most at-risk groups for HIV transmission and comprehensive sexual health care and literacy can change that statistic. Syringe exchange programs are a harm reduction solution which much be implemented to meet the ongoing opioid crisis, which has created spikes in the transmission and incidence of HIV and viral hepatitis. Rather than criminalizing people who inject drugs, create spaces where they can access clean needles will help stem the spread of infectious diseases. “End the Epidemic” planning must be committed to a structural approach addressing the social determinants of HIV transmission and prevention.